In a time when we now understand more clearly the causes and effects of disease, we have at our disposal the means with which to avoid many sources of infection: the use of sanitary methods, especially hand washing. Unfortunately, most people simply don't perform the task as well or as often as needed. The main problem is that germs are too small to see. People can't simply wash off visible dirt and expect their hands to be “clean”. Additionally, people, for whatever reason, do not spend the adequate amount of time necessary to properly clean their hands.
Experts agree that effective hand washing requires both soap and water. (Merely rinsing one's hands with water alone will not suffice.) The hands must be wet thoroughly and lathered with soap. Then the individual must rub the soapy water all over the hands and fingers for at least twenty (20) to thirty (30) seconds, including underneath the fingernails, and then rinse thoroughly to ensure proper sanitation has occurred. Unfortunately, people simply don't do this. “Want to Help Fight Disease? Just Wash Your Hands.” www.yourskinandsun.com/article1039.html (Aug. 18, 2003).
While businesses such as restaurants and hospitals frequently install signs in restrooms to remind their employees that they “must” wash their hands before returning to work, there has never been an effective way for an employer or other supervisor to monitor if this hand washing did, in fact, occur (unless sinks are installed in the work area and heavily monitored). Further, even if an employee has washed their hands, there has never been a way to ensure that the hands are satisfactorily clean, or if substandard sanitary practices have occurred. The problem is not limited to businesses or institutions alone. Every day parents, guardians, and care givers everywhere lament children's hand washing practices. Further, these selfsame care givers have never had a way to ensure that their own hands, much less the children's hands, were properly washed as well. Given the virulence of bacteria and viruses emerging in the world scene now, it is becoming ever more important to ensure proper hand washing has occurred.
The Centers for Disease Control and Prevention (CDC) estimates that approximately 76 million people suffer from food borne illnesses and 5,000 die from these illnesses in the United States each year. The CDC, in a review of contributing factors to food borne disease outbreaks over a five year period, estimated that poor personal hygiene was a contributing factor in over a third of the outbreaks.
In a study reported in the Journal of Infectious Diseases in Children, fecal coli-forms were detected on the hands of some twenty (20) percent of daycare staff evaluated. Further, a third of the facilities studied had poor hand washing systems and no policy for hand washing before eating or after playing outside. (Kendall, Pat, “Hand Washing Important to Preventing Spread of Disease”, Colorado State University Cooperative Extension, www.ext.colostate.edu/pubs/columnnn/nn010320.html. (Mar. 20, 2001).) These are particularly worrisome numbers when the type of infectious diseases common to these child care facilities are considered.
Diseases with respiratory tract symptoms are often spread by airborne droplets or by surfaces contaminated with nose/throat discharges. The sneezing and coughing of an infected child can result in some of the germs becoming air-borne. In addition, sick children will often contaminate their hands and other objects with infectious nasal/throat discharges. Some of the infections passed in this way are the common cold, chickenpox, influenza, measles, meningitis (viral and bacterial), mumps, whooping cough (pertussis), rubella, streptococcal infection, and viral gastroenteritis. Intestinal tract infections are often spread through exposure to viruses, bacteria, or parasites in the feces and are transmitted by the fecal-oral route. This means that the germs leave the body of the infected person in the feces and enter the body of another person through the mouth. In most situations, this happens when objects that have become contaminated with undetectable amounts of feces are placed in the mouth. (Fecal-oral transmission can also occur when food or water is contaminated with undetectable amounts of human or animal feces.) Studies have shown that the sites most frequently contaminated with feces are hands, classroom floors, toilet flush handles, toys and tabletops. Germs spread in this way include: Campylobacter species, cryptosporidium, E. coli O157, Giardia, hepatitis A (infectious hepatitis), Salmonella species, Shigella species, and a variety of intestinal viruses. (Colorado Dept. of Public Health and Environment, “Infectious Disease In Child Care Settings: Guidelines for Child Care Providers” December 2002; www.cdphe.state.co.us/dc.epidemiology/ChildCareflipchart02a.pdf.)
Clearly, there is a grave health risk present when proper sanitary methods are not employed and diseases, not limited to those listed above, are spread. Physicians agree that the best way to prevent the spread of illness is washing the hands properly, but how can one be sure that hands have been washed properly, whether in a home, daycare, medical, industrial, commercial or other setting? The present art does not allow for real time testing of the hands or other small objects to check for contaminants. Therefore, there is a strong felt need in the art for an apparatus and method for real time testing of hands or other body parts for contaminants in order to avoid unnecessary transmission of such contaminants.
Further, this danger can be extended. Small items may also carry germs that can put one's health at risk. A dropped pacifier or a toy handled by another child can easily transmit germs to a healthy child. To carry the analogy to the business world, a spatula dropped in a restaurant can become contaminated with whatever germs the restaurant's employees have “walked in”. (Germs are often carried on shoes.) Further, there are conceivable instances where the utmost care should be taken in disease or contaminant prevention: hospitals, in particular, operating rooms or intensive care units, and clean rooms for industry. These types of specialized environments require the highest level of cleanliness. Unfortunately, until now, the most relied on “check” for cleanliness has been the honor system—trusting workers to sufficiently scrub up.
The problems the honor system creates can be clearly seen in the CDS's own “Guideline for Hand Hygiene in Heath-Care Settings: Recommendations of the Healthcare Infection Control Practice Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force”, published at www.cdc/gov/mmwr/preview/mmwrhtml/rr5116a1.htm and at MMWR Recommendations and Reports 51 (RR16); 1-44 (Oct. 25, 2002). This guide sets forth the state of the art: that the performance indicator for hand washing is for health care facilities to periodically monitor and record adherence as the number of hand-hygiene episodes performed by personnel/number of hand hygiene opportunities and to provide feedback to the personnel. Therefore, the only feedback that could be given would be subjective based on the number of hand washings and, likely, the duration. There is no method or apparatus in use to actually check for contamination.
There is clearly a need in the art for actual contaminant detection capability to facilitate a quick, reliable answer to individuals in industry, healthcare, and on a personal basis of the presence of contaminants. Further, the process needs to be repeatably reliable. Additionally, it would be extremely desirable to avoid complicated processes such as plating specimens in order to detect contaminants. Clearly unusable in a home situation, such detection methods are so time consuming as to be non-useful in other situations (such as commercial or medical) as well. Furthermore, there is a need in the art for identification of individuals in industry or healthcare that have not adequately cleaned their hands in hand washing. Subjective monitoring is not sufficient and impractical for continued monitoring.